Frontiers in medicine · 2026
Timing of renal replacement therapy in acute kidney injury after liver transplantation: the clinical value of the NMF standards.
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Ye Gong-Jie, Dong Zhou-Zhou
Аннотация
OBJECTIVE: To evaluate the utility of the NMF standards-comprising intraoperative norepinephrine dosage, preoperative MELD-Na score, and total intraoperative fluid intake-in determining the optimal timing for initiating renal replacement therapy (RRT) in patients with acute kidney injury (AKI) following liver transplantation.
METHODS: The NMF standards were developed and validated in two studies: (1) a retrospective cohort study (2018-2023, 189 patients with KDIGO stage 2 AKI) stratified by NMF status and RRT timing into four groups (A, B, C, D); and (2) a historically controlled cohort study (2024-2025, 76 NMF-guided patients vs. 189 historical controls managed by clinical judgment). The primary outcomes included renal function indicators, hospital stay, CKD incidence, and long-term RRT dependence.
RESULTS: The NMF standards have been validated as a robust clinical tool: intraoperative norepinephrine ≥6.5 μg·kg-1·h-1, preoperative MELD-Na ≥15.5, and total fluid intake ≥6,600 ml. In the retrospective cohort, patients meeting NMF standards who received timely RRT exhibited significantly better renal function, lower blood ammonia, shorter hospital stay, and lower rates of CKD and long-term RRT dependence than those with delayed or no RRT. For patients not meeting the NMF standards, early RRT did not show significant long-term benefits in this small subgroup, but was associated with an increased risk of catheter-related bloodstream infection. In the historically controlled cohort study, NMF-guided RRT significantly improved 7-day creatinine (64.5 vs. 72.2 μmol/L), shortened hospital stay (24.0 vs. 27.5 days), and reduced CKD (14.5% vs. 24.5%) and long-term RRT dependence (7.9% vs. 18.5%) compared with clinically guided RRT.
CONCLUSIONS: The NMF standards, integrated with a user-friendly WeChat mini-program, provide a validated and practical framework for optimizing RRT timing in AKI post-liver transplantation. This tool enhances clinical decision-making, reduces complications, and improves long-term renal outcomes.
METHODS: The NMF standards were developed and validated in two studies: (1) a retrospective cohort study (2018-2023, 189 patients with KDIGO stage 2 AKI) stratified by NMF status and RRT timing into four groups (A, B, C, D); and (2) a historically controlled cohort study (2024-2025, 76 NMF-guided patients vs. 189 historical controls managed by clinical judgment). The primary outcomes included renal function indicators, hospital stay, CKD incidence, and long-term RRT dependence.
RESULTS: The NMF standards have been validated as a robust clinical tool: intraoperative norepinephrine ≥6.5 μg·kg-1·h-1, preoperative MELD-Na ≥15.5, and total fluid intake ≥6,600 ml. In the retrospective cohort, patients meeting NMF standards who received timely RRT exhibited significantly better renal function, lower blood ammonia, shorter hospital stay, and lower rates of CKD and long-term RRT dependence than those with delayed or no RRT. For patients not meeting the NMF standards, early RRT did not show significant long-term benefits in this small subgroup, but was associated with an increased risk of catheter-related bloodstream infection. In the historically controlled cohort study, NMF-guided RRT significantly improved 7-day creatinine (64.5 vs. 72.2 μmol/L), shortened hospital stay (24.0 vs. 27.5 days), and reduced CKD (14.5% vs. 24.5%) and long-term RRT dependence (7.9% vs. 18.5%) compared with clinically guided RRT.
CONCLUSIONS: The NMF standards, integrated with a user-friendly WeChat mini-program, provide a validated and practical framework for optimizing RRT timing in AKI post-liver transplantation. This tool enhances clinical decision-making, reduces complications, and improves long-term renal outcomes.